Laryngeal (larynx) cancer

The larynx is also called the voice box. It sits in the neck, above the windpipe (trachea) and in front of the gullet (oesophagus). The larynx lets the air you breathe in reach your lungs. It also holds the 2 vocal cords, which vibrate together when air passes between them, and that makes the sound of your voice. Laryngeal cancer is also called cancer of the larynx. Around 2,360 people in the UK are diagnosed with cancer of the larynx each year.

Most cancers of the larynx are squamous cell carcinoma. This means the cancer starts in the thin, flat cells that line the larynx.

Some rarer types of cancer of the larynx include:

• sarcoma, which is cancer of the connective tissues in the larynx
• lymphoma, which is cancer of the lymphatic tissue in the larynx
• adenocarcinoma, which is cancer that starts in the glandular (adeno) cells of the larynx
• neuroendocrine carcinoma, which is cancer that develops from cells similar to nerve (neuro) cells that make hormones (endocrine)

Hormones control how different organs in the body work.

This information is about treatment for squamous cell cancer of the larynx. For the rarer types, you can contact Macmillan Cancer Support for information.

The most common symptom of laryngeal cancer is a change in your voice, such as hoarseness. Macmillan Cancer Support has more information about the signs and symptoms.

Doctors don't know the exact cause of laryngeal cancer. But some risk factors can raise your chance of developing it.

Having one or more of them doesn't mean you'll definitely get laryngeal cancer. Some people with risk factors never get cancer. And other people can develop cancer of the larynx without any known risk factor, although this isn't common.

This type of cancer is rare in people under the age of 40. It's more common in people over 60, and it's 4 times more common in men than in women.

The main risk factors are smoking tobacco and drinking alcohol.

Your risk of cancer of the larynx goes up the longer you smoke and the more you smoke.

Get advice about stopping smoking

Drinking a lot of alcohol over a long time, especially spirits, raises your risk of developing cancer of the larynx. The risk is higher if you smoke and also drink a lot of alcohol.

Get advice and support with alcohol

Like other cancers, laryngeal cancer is not infectious. This means you can't pass it on to other people.

If you have symptoms of laryngeal cancer, you'll usually start by seeing your doctor. They'll examine you and may arrange some tests.

They might refer you to an ear, nose and throat (ENT) doctor or a specialist clinic.

The specialist will:

• ask about your symptoms
• check your general health
• ask whether you take any medicines
• feel for lumps in your neck

Swollen lymph nodes may be causing these lumps. Other medical conditions, like a swollen salivary gland, can also cause lumps.

After examining you carefully, the specialist will explain what tests you need. This may include the following tests.

Doctors use a nasendoscopy to look at the back of your mouth and throat.

A laryngoscopy lets the doctor look closely at your larynx. If any tissue in the area looks abnormal, the doctor takes a small sample of cells (a biopsy) during the same procedure.

A fine needle aspiration, or FNA, is a simple test doctors use to check lumps in your neck.

If cancer cells are found in your larynx, your doctor will ask you to have a few more tests. These help you and your doctor decide on the right treatment for laryngeal cancer.

You may have blood tests to check your general health and to see which treatments may suit you.

A CT scan gives your doctor a detailed picture of the inside of your body. The scanner takes X-rays, and these are put together to build up the picture.

An MRI scan uses magnetism to build up a detailed picture of areas inside your body.

A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body. It can give more detailed information about cancer or abnormal areas seen on X-rays, CT scans or MRI scans.

You may have a PET scan and a CT scan together. This is called a PET-CT scan.

Waiting for test results can be a difficult time, and support can help.

Once your tests are done, your doctors use the results to work out the size and position of the cancer, and whether it has spread. This is called staging.

The grade is decided by a doctor who looks at the cancer cells under the microscope. How the cells look gives an idea of how quickly the cancer might grow or spread.

Once your doctors know the stage and grade of the laryngeal cancer, they can decide which treatment is best for you.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). Your cancer doctor or specialist nurse will explain the different treatments and their side effects. It can help to write down any questions before you see them. They'll also talk to you about the things you should consider when making treatment decisions.

Treatment for laryngeal cancer depends on:

• where the cancer is in the larynx
• the size of the cancer and whether it has spread (its stage)
• how fast-growing the cancer is (its grade)
• your general health

Macmillan Cancer Support have more information about laryngeal cancer treatment.

The main treatments for early stage laryngeal cancer are radiotherapy and surgery. Other treatments may be used for locally advanced and advanced laryngeal cancer.

Radiotherapy for laryngeal cancer uses high-energy rays to destroy the cancer cells. Doctors can give it on its own, together with chemotherapy (this is called chemoradiation), or alongside a targeted therapy drug.

If you have early stage laryngeal cancer, you may have surgery through your mouth. When the tumour is large, you may need an operation to remove part or all of the larynx (this is called a laryngectomy).

Some people also have surgery to remove cancer that has spread to nearby lymph nodes (a neck dissection).

When you have chemotherapy at the same time as radiotherapy, it's called chemoradiation. For laryngeal cancer (cancer of the larynx), it may be your main treatment if the cancer is locally advanced. It may also be used if the cancer can't be removed with surgery.

Doctors sometimes use chemoradiation after surgery too, to reduce the risk of the cancer coming back (this is called adjuvant treatment).

Doctors can give chemotherapy for laryngeal cancer before surgery or after it. It can be given on its own, or together with radiotherapy. Sometimes it's used to slow the growth of the cancer and keep symptoms under control, and this is called palliative chemotherapy.

Targeted therapy uses drugs that find and attack cancer cells. There are many different types, and each one goes after something in or around the cancer cell that is helping it grow and survive.

For laryngeal cancer, the targeted therapy used most often is cetuximab (Erbitux®).

Your immune system is the body's defence against illness and infection. Immunotherapy uses it to find and attack cancer cells. For laryngeal cancer, the immunotherapy drugs used are nivolumab and pembrolizumab.

You can have these treatments on their own or combined with each other.

Macmillan Cancer Support has information that can help you understand treatments better. You can read more about:

• preparing for laryngeal cancer treatment
• having treatment as part of a clinical trial

Once your treatment has finished, you'll have regular follow-up appointments with your medical team. These may continue for several years.

Tell your doctor about any new symptoms, or any symptoms that are not getting better. Don't wait until your next appointment to do it.

You may feel anxious between appointments. This is natural. Support from family and friends, or from a support organisation, may help.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan laryngeal (larynx) cancer forum, where you can talk to others affected by laryngeal cancer, ask questions and share your experience

Recovery after treatment for laryngeal cancer can take time. You may notice physical changes in the way you look, and you may have to cope with changes in your daily life, like how you speak and eat.

Even if you already live a healthy life, you might choose to make some positive changes after treatment. There are things you can do to help your body recover and improve your sense of wellbeing.

Giving up smoking can be difficult, but there's a lot of support available.

Get advice on how to stop smoking.

Drinking alcohol raises your risk of developing another head and neck cancer, on top of laryngeal cancer. If you stop drinking or cut down the amount you drink, you can lower that risk.

Get support with alcohol

Eating well can be hard after treatment for laryngeal cancer, but your dietician can help you with it. Good food and staying active will help you keep up your strength, give you more energy and improve your sense of wellbeing.

Complementary therapies such as yoga or meditation can help you feel better, and they can also reduce stress and anxiety if you have laryngeal (larynx) cancer.

Talk to your cancer doctor or specialist nurse first, though. Some therapies may not be suitable alongside certain cancer treatments.

Cancer and the treatment for it can affect your sexual confidence, both in your body and in your feelings. Some people also struggle with how they see their body after treatment.

Laryngeal cancer (cancer of the larynx) and its treatments can change how you feel about kissing and having sex. This usually gets better over time.

Some side effects of laryngeal cancer treatment take time to get better, and sometimes they become permanent.

Other side effects show up some time after treatment has finished. These are called late effects. Macmillan Cancer Support has more information about the late effects of laryngeal cancer treatment.

For some people, it may take several months to recover from treatment. It can be hard to cope if treatment has changed how you look, how your voice sounds, or how you eat and drink. Many people feel overwhelmed by different feelings, and that's common.

Organisations that offer information and support include:

• Changing Faces, which offers advice and information to anyone affected by a change in their appearance
• Cancer Laryngectomee Trust, which provides support to people who are about to have, or have had, a laryngectomy
• National Association of Laryngectomee Clubs, which aims to promote the welfare of people who have had a laryngectomy, and their families
• The Swallows, which offers face-to-face support groups across the UK and online support groups for people with head and neck cancers, and for those who care for them

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